Alternative Payment Models

As the healthcare system considers alternative payment models that reward high-value care delivery, programs that utilize lay health workers (LHW) may be valuable. A study in JAMA Oncology analyzed whether an LHW program can increase the documentation of patients’ care preferences.

This week, the top managed care stories included encouraging results from the Next Generation Accountable Care Organization model; concerns that CMS' new billing rules will hurt the sickest patients; a study confirms the value of daily aspirin for patients with diabetes.

Suzanne Delbanco, PhD, MPH, executive director of Catalyst for Payment Reform, explains how her organization is helping employers better understand accountable care organizations (ACOs) and judge how the ACO model might work with their population.

In 2016, the Next Generation Accountable Care Organization (ACO) model generated a net savings of $62 million to Medicare, representing a 1.1% net reduction in Medicare spending. In a webcast with the Accountable Care Learning Collaborative, CMS Administrator Seema Verma called the results a strong start and offered a look at what's in the future for the model.

In a new commentary in JAMA Internal Medicine, authors highlighted the results of the hospital-at-home (HaH) program at Mount Sinai Health System that resulted in the Physician-Focused Payment Model Technical Advisory Committee recommending full implementation of the bundled HaH program, as well as clinical and policy issues raised by the program.

Physician- and nursing staff–reported team functioning was associated with patient satisfaction but not with clinical quality or patient portal implementation.

The proposed Medicare Shared Savings Program rule has many sweeping changes that present a number new opportunities, but also challenges. In addition, the National Association of ACOs highlighted its concerns that the changes will decrease the number of ACOs and may discourage new entrants.

Tim Gronniger, MPP, MHSA, senior vice president of development and strategy at Caravan Health, discusses the struggles that organizations face when attempting to make a switch to new payment models, and how that switch can be improved in the future.

Payment reform efforts that don't engage patients are missing out on an opportunity for greater improvements, especially in cancer, where patients face substantial cost sharing.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Accountable care organizations (ACOs), either directly or indirectly, are affecting physician employment patterns in regions where they have high penetration.

This week, the top managed care stories included CMS outlining a plan to encourage Medicare accountable care organizations to take on more risk, faster; a study found substantial growth in Medicaid managed care enrollment; an analysis showed nearly 1 in 5 inpatient hospital stays includes a claim from an out-of-network provider.

The first in a series of articles that identifies CMS' goals in updating the Medicare Shared Savings Program and how well the proposals make taking on more risk appealing for accountable care organizations.

Hospital leaders are concerned about how to get ready to take on more risk, said Tim Gronniger, MPP, MHSA, senior vice president of development and strategy at Caravan Health.

A new rule in the Medicare Access and CHIP Reauthorization Act’s 2019 Quality Payment Program and the proposed 2019 Medicare Physician Fee Schedule could negatively affect the quality of cancer care for Medicare beneficiaries, according to the American Society of Clinical Oncology.

A new study found hospital participation in 5 common medical bundles under the Bundled Payments for Care Improvement initiative was not associated with significant changes in Medicare payments, clinical complexity, length of stay, emergency department use, hospital readmission, or mortality.

Payment reforms efforts are still facing barriers, but buy-in and increased demand from self-insured employers can help spur widespread adoption of new payment models that will lead to health delivery system reforms, according to a commentary published in New England Journal of Medicine.

When the CMS released performance reports for the 181 practices enrolled in the Oncology Care Model (OCM) earlier this year, the action had the effect of creating as much confusion as it resolved.

With the evaluation period for the Oncology Care Model at its midway point, there is an opportunity to discuss how the program and other bundled payment programs can better deliver on aims to provide higher quality care at the same or lower cost.

As value-based pricing gains traction in the US healthcare market, "distinctions in both method and likelihood of improving aligning prices with value should be carefully considered," write authors in JAMA.

Health plans continue to show interest in expanding outcomes-based contracts, according to an Avalere Health study that also found cardiovascular diseases, infectious diseases, and oncology represent the most common therapeutic areas to have these contracts.

Adam Boehler, director of the Center for Medicare & Medicaid Innovation, is taking on an additional role as the senior advisor for value-based transformation and innovation. He represents the last departmental appointment as part of HHS Secretary Alex Azar's 4 priority areas.

The implementation of alternative payment models that successfully capture clinical heterogeneity—without adding unacceptable levels of administrative complexity—may be equally (if not more) important than site-neutral payment policies.

After 5 years of research, the Hutchinson Institute for Cancer Outcomes Research has released a report that is the first in the nation to publicly report clinic-level quality measures linked to cost in oncology.

Experience with risk-based contracting best predicts active engagement of accountable care organizations in reducing low-value medical services, mainly through physician education and encouraging shared decision making.

The shift to value-based care has stalled since 2017, according to a survey of health plan executive and providers commissioned by Quest Diagnostics. Quest said its third annual study suggests that physicians need better tools, like data access, and less complex quality measures to spur adoption of value-based healthcare, which focuses on care quality and patient outcomes rather than the quantity of services delivered.

Quality measurement has been around for nearly 2 decades and in that time measures have evolved and also proliferated to the point of placing considerable burden on physicians and health systems. New efforts are being made to streamline current measures, fill in gaps, and harmonize measures across programs.

This article compares clinical and utilization profiles of Medicare patients who are attributed to provider groups with those of patients unattributed to any provider group in accountable care organization models.

A study found that hospitals participating in Medicare’s Bundled Payments for Care Improvement and hospitals not participating are dissimilar in meaningful ways that limit the generalizability of the program's results.